Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland

Background: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce.Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing.Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach >80% agreement for acceptance.Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation.Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged.

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Refuting Spurious COVID-19 Treatment Claims Reduces Demand and Misinformation Sharing

10.31234/osf.io/q3mkd ◽

2020 ◽

Author(s):

Douglas MacFarlane ◽

Li Qian Tay ◽

Mark J. Hurlstone ◽

Ullrich K. H. Ecker

Keyword(s):

Practice Guidelines ◽

Best Practice ◽

Opportunity Costs ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Health Authorities ◽

Novel Approach ◽

Materials Used ◽

The Impact ◽

Treatment Claims

The COVID-19 pandemic has seen a surge of health misinformation, which has had serious consequences including direct harm and opportunity costs. We investigated (N = 678) the impact of such misinformation on hypothetical demand (i.e., willingness-to-pay) for an unproven treatment, and propensity to promote (i.e., like or share) misinformation online. This is a novel approach, as previous research has used mainly questionnaire-based measures of reasoning. We also tested two interventions to counteract the misinformation, contrasting a tentative refutation based on materials used by health authorities with an enhanced refutation based on best-practice recommendations. We found prior exposure to misinformation increased misinformation promotion (by 18%). Both tentative and enhanced refutations reduced demand (by 18% and 25%, respectively) as well as misinformation promotion (by 29% and 55%). The fact that enhanced refutations were more effective at curbing promotion of misinformation highlights the need for debunking interventions to follow current best-practice guidelines.

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Development of best practice recommendations for the safe use of pulmonary hypertension pharmacotherapies using a modified Delphi method

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxy020 ◽

2019 ◽

Vol 76 (3) ◽

pp. 153-165 ◽

Cited By ~ 3

Author(s):

Zachary R Smith ◽

Krishna Rangarajan ◽

Jennifer Barrow ◽

Danielle Carter ◽

James C Coons ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Delphi Method ◽

Best Practice ◽

Modified Delphi Method ◽

Practice Recommendations ◽

Modified Delphi

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Best practice guidelines for stroke in Cameroon: An innovative and participatory knowledge translation project

African Journal of Disability ◽

10.4102/ajod.v3i1.92 ◽

2014 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Lynn Cockburn ◽

Timothy N. Fanfon ◽

Alexa Bramall ◽

Eta M. Ngole ◽

Pius Kuwoh ◽

...

Keyword(s):

Patient Outcomes ◽

Practice Guidelines ◽

Stroke Rehabilitation ◽

Best Practice ◽

Guideline Development ◽

Front Line ◽

African Countries ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Successes And Challenges

Background: Although the adherence to stroke guidelines in high-income countries has been shown to be associated with improved patient outcomes, the research, development and implementation of rehabilitation related guidelines in African countries is lacking.Objectives: The purpose of this article is to describe how a group of front-line practitioners collaborated with academics and students to develop best practice guidelines (BPG) for the management and rehabilitation of stroke in adult patients in Cameroon.Method: A working group was established and adapted internationally recognised processes for the development of best practice guidelines. The group determined the scope of the guidelines, documented current practices, and critically appraised evidence to develop guidelines relevant to the Cameroon context.Results: The primary result of this project is best practice guidelines which provided an overview of the provision of stroke rehabilitation services in the region, and made 83 practice recommendations to improve these services. We also report on the successes and challenges encountered during the process, and the working group’s recommendations aimed at encouraging others to consider similar projects.Conclusion: This project demonstrated that there is interest and capacity for improving stroke rehabilitation practices and for stroke guideline development in Africa.

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Application of a Participatory Ergonomic Approach for Scaling Handoff Redesign: A Pilot Feasibility Study

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857920091016 ◽

2020 ◽

Vol 9 (1) ◽

pp. 283-288

Author(s):

Louise Gliga ◽

Isaac Lynch ◽

Richard Preble ◽

Philip Greilich

Keyword(s):

Participatory Design ◽

Best Practice ◽

Medical Center ◽

Academic Medical Center ◽

Care Transitions ◽

Implementation Process ◽

Scaling Up ◽

Transitions Of Care ◽

Modified Delphi ◽

Best Practice Guidelines

Transitions of care between clinical areas are potentially dangerous events in healthcare. This is especially true in high risk areas, such as between the operating room (OR) and the intensive care unit (ICU). Despite the existence of best practice guidelines for perioperative handoffs, scaling up successful pilots remains a challenge. To more effectively address this limitation, we tested the feasibility of using a participatory ergonomic approach for scaling handoff redesign and implementation in an academic medical center. A multidisciplinary unit-based change team of representatives and influencers was supported by a guidance team of leaders, coaches and subject matter experts through a structured implementation process (plan, engage, execute, reflect). The participatory design incorporated a modified Delphi technique, simulation, and facilitated debriefing to elicit feedback in multiple iterative cycles. The redesigned handoff became the preferred approach by frontline clinicians across the involved disciplines and resulted in a sustained improvement in conformance to unit-determined handoff best practices. The success of this feasibility pilot has led to the support of a diffusion pilot for scaling up handoff redesign within the health system. The study supports further investigation of using a participatory ergonomics approach to engage frontline clinicians and executive leadership to scale complex sociotechnical change, like handoffs and care transitions.

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Crowdsourcing for Research: Perspectives From a Delphi Panel

SAGE Open ◽

10.1177/2158244020980751 ◽

2020 ◽

Vol 10 (4) ◽

pp. 215824402098075

Author(s):

H. Bassi ◽

L. Misener ◽

A. M. Johnson

Keyword(s):

Problem Solving ◽

Best Practice ◽

Decision Aids ◽

Delphi Panel ◽

Modified Delphi ◽

Best Practice Guidelines ◽

Research Perspectives ◽

Health Related Research ◽

Health Related ◽

Modified Delphi Technique

Crowdsourcing, an open call for the public to collaborate and participate in problem solving, has been increasingly employed as a method in health-related research studies. Various reviews of the literature across different disciplines found crowdsourcing being used for data collection, processing, and analysis as well as tasks such as problem solving, data processing, surveillance/monitoring, and surveying. Studies on crowdsourcing tend to focus on its use of software, technology and online platforms, or its application for the purposes previously noted. There is need for further exploration to understand how best to use crowdsourcing for research, as there is limited guidance for researchers who are undertaking crowdsourcing for the purposes of scientific study. Numerous authors have identified gaps in research related to crowdsourcing, including a lack of decision aids to assist researchers using crowdsourcing, and best-practice guidelines. This exploratory study looks at crowdsourcing as a research method by understanding how and why it is being used, through application of a modified Delphi technique. It begins to articulate how crowdsourcing is applied in practice by researchers, and its alignment with existing research methods. The result is a conceptual framework for crowdsourcing, developed within traditional and existing research approaches as a first step toward its use in research.

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Inappropriate prescription of antibiotics in pediatric practice

Journal of Child Health Care ◽

10.1177/1367493516643421 ◽

2016 ◽

Vol 20 (4) ◽

pp. 530-536 ◽

Cited By ~ 6

Author(s):

Clémence Marc ◽

Bénédicte Vrignaud ◽

Karine Levieux ◽

Antoine Robine ◽

Christèle Gras-Le Guen ◽

...

Keyword(s):

Best Practice ◽

Bacterial Resistance ◽

Antibiotic Prescription ◽

University Hospital ◽

Upper Respiratory Tract ◽

Practice Recommendations ◽

Health Authorities ◽

Antibiotic Drugs ◽

Antibiotic Drug ◽

Upper Respiratory

Misuse of antibiotics is largely responsible for the emergence of bacterial resistance. Children represent a subset of the population who frequently receive antibiotics. The objectives were to calculate the frequency of antibiotic prescriptions that do not comply with best practice recommendations in paediatrics primary care and to examine the thoughts and feelings of physicians and parents about antibiotic prescription and recommendations from the national health authorities. We included children admitted at the paediatric emergency room (PER) of the NANTES university hospital between June 2011 and October 2012 and who were under antibiotic drugs. Two independent experts evaluated the compliance with the national recommendations. Parents and general practitioner (GP) who prescribed the antibiotic before admission to PER were called to collect their thoughts and feeling about antibiotic prescription. The median age of the 88 included children was 2.8 years. The upper respiratory tract infection motivated the prescription of antibiotic in 59%. Seventy-six per cent of the prescriptions analysed were inappropriate, 72% of the antibiotics had a too broad spectrum, and one-third was not indicated. Ninety-one per cent of the interviewed parents thought that the antibiotic prescribed to their child was adequate. Among the 77 prescribing GP who were called, 33% agreed that they lacked time during consultation to explain to parents that no antibiotics were required. Antibiotic prescriptions were too often inadequate in this sample of children admitted in a French PER. Efforts have to be made with physicians and general public to optimize the antibiotic drug use.

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E.02 Streamlining hyperacute stroke management at Royal University Hospital

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.86 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S16-S16

Author(s):

AJ Szmigielski ◽

R Whelan ◽

B Graham ◽

G Hunter ◽

L Peeling ◽

...

Keyword(s):

Best Practice ◽

Retrospective Chart Review ◽

Stroke Care ◽

University Hospital ◽

Vessel Occlusion ◽

Escape Trial ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Number Of Patients ◽

Software Changes

Background: The Saskatoon stroke program participated in the ESCAPE trial looking at rapid endovascular revascularization for large vessel occlusion. Improvements were necessary to meet the timelines mandates in ESCAPE and to comply with Canadian Best Practice Guidelines. Methods: Retrospective chart review and prospective gathering of key metrics was performed using REDCap (Research Electronic Data Capture) software. Changes adapted from Canadian Best Practice Recommendations for Stroke Care, the ESCAPE protocol, and the Calgary stroke program HASTE project were implemented. Results: Changes implemented included increasing ambulance bypass window to 12 hours, FAST stroke assessment, emergency department pre-notification and registration, stroke alert protocol, team swarm of the patient, administration of tPA in the computed tomography (CT) room, and rapid access to the endovascular suite. Total number of patients between the years 2012 and 2014 was 287, and of those, 93 received tPA. Door-to-CT times decreased from 40 minutes to 21 minutes from 2012 to 2014; and Door-to-Needle (tPA) decreased from 62 minutes to 46 minutes from 2012 to 2014. Conclusions: By following Canadian best practice recommendations for stroke care, the ESCAPE protocol, and adaptation of Calgary stroke program HASTE project, our stroke program implemented changes to reduce treatment times for patients experiencing stroke in our province.

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Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017

International Journal of Stroke ◽

10.1177/1747493017706239 ◽

2017 ◽

Vol 12 (8) ◽

pp. 886-895 ◽

Cited By ~ 22

Author(s):

Dylan Blacquiere ◽

M Patrice Lindsay ◽

Norine Foley ◽

Colleen Taralson ◽

Susan Alcock ◽

...

Keyword(s):

Best Practice ◽

Healthcare Providers ◽

Occupational Therapists ◽

Remote Access ◽

Stroke Recovery ◽

Current Evidence ◽

Virtual Rehabilitation ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Ischemic Attack

Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. The 2016 update of the Canadian Stroke Best Practice Recommendations Telestroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. These recommendations focus on the use of telemedicine technologies to rapidly identify and treat appropriate patients with acute thrombolytic therapies in hospitals without stroke specialized expertise; select patients who require to immediate transfer to stroke centers for Endovascular Therapy; and for the patients who remain in community hospitals to facilitate their care on a stroke unit and provide remote access to stroke prevention and rehabilitation services. While these latter areas of Telestroke application are newer, they are rapidly developing, with new opportunities that are yet unrealized. Virtual rehabilitation therapies offer patients the opportunity to participate in rehabilitation therapies, supervised by physical and occupational therapists. While not without its limitations (e.g., access to telecommunications in remote areas, fragmentation of care), the evidence-to-date sets the foundation for improving access to care and management for patients during both the acute phase and now through post stroke recovery.

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“So Many Mental Health Issues Go Unsaid”: Implications for Best Practice Guidelines From Student-Athletes’ Perspectives About Service Availability

Journal of Clinical Sport Psychology ◽

10.1123/jcsp.2019-0051 ◽

2020 ◽

Vol 14 (3) ◽

pp. 305-324

Author(s):

William C. Way ◽

Ashley M. Coker-Cranney ◽

Jack C. Watson

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Best Practice ◽

Student Athletes ◽

National Collegiate Athletic Association ◽

Service Availability ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Perceived Access

Using the framework of multidisciplinary best practice recommendations promoted by the National Collegiate Athletic Association, this study used a mixed-methods approach to investigate Division I student-athletes’ perceived access to and satisfaction with mental health service availability. Participants were asked about their satisfaction with direct (e.g., counseling, psychiatry, assessment) and indirect (e.g., mental health outreach, educational workshops) service availability, both on campus and within athletics. Results from a researcher-generated survey indicated that participants were moderately satisfied with service availability in each of the four contexts. Hierarchical multiple regressions revealed that student-athletes’ satisfaction was predicted by different factors for each service type-location combination. Qualitative data contained requests for more athlete-centered mental health services as well as more preventative outreach in general. These data provide a foundation for understanding factors that influence student-athletes’ satisfaction with mental health service availability and offer practical implications for current best practice recommendations.

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Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus

Gut ◽

10.1136/gutjnl-2020-322329 ◽

2020 ◽

Vol 69 (11) ◽

pp. 1915-1924 ◽

Cited By ~ 2

Author(s):

Pradeep Bhandari ◽

Sharmila Subramaniam ◽

Michael J Bourke ◽

Asma Alkandari ◽

Philip Wai Yan Chiu ◽

...

Keyword(s):

Delphi Method ◽

Healthcare Workers ◽

Best Practice ◽

Delphi Consensus ◽

International Consensus ◽

Practice Recommendations ◽

Modified Delphi ◽

Consensus Statements ◽

And Control ◽

Diagnostic Delays

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.

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